Provider Demographics
NPI:1124301536
Name:GORDER, KATHERINE E (MS, CFY-SLP)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:E
Last Name:GORDER
Suffix:
Gender:F
Credentials:MS, CFY-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2662 E JOYCE BLVD
Mailing Address - Street 2:STE 3
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-4554
Mailing Address - Country:US
Mailing Address - Phone:479-521-7337
Mailing Address - Fax:
Practice Address - Street 1:2662 E JOYCE BLVD
Practice Address - Street 2:STE 3
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4554
Practice Address - Country:US
Practice Address - Phone:479-521-7337
Practice Address - Fax:479-521-7338
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#P8471235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist